A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis.
OBJECTIVE
Oxidative stress has been implicated in the pathophysiology of chronic pancreatitis (CP). We evaluated the effects of antioxidant supplementation on pain relief, oxidative stress, and antioxidant status in patients with CP.


METHODS
In a placebo-controlled double blind trial, consecutive patients with CP were randomized to groups that were given placebo or antioxidants for 6 months. The primary outcome measure was pain relief, and secondary outcome measures were analgesic requirements, hospitalization, and markers of oxidative stress (thiobarbituric acid-reactive substances [TBARS]) and antioxidant status (ferric-reducing ability of plasma [FRAP]).


RESULTS
Patients (age 30.5+/-10.5 years, 86 male, 35 alcoholic, and 92 with idiopathic CP) were assigned to the placebo (n=56) or antioxidant groups (n=71). After 6 months, the reduction in the number of painful days per month was significantly higher in the antioxidant group compared with the placebo group (7.4+/-6.8 vs 3.2+/-4, respectively; P< .001; 95% CI, 2.07, 6.23). The reduction in the number of analgesic tablets per month was also higher in the antioxidant group (10.5+/-11.8 vs 4.4+/-5.8 respectively; P= .001; 95% CI, 2.65, 9.65). Furthermore, 32% and 13% of patients became pain free in the antioxidant and placebo groups, respectively (P= .009). The reduction in the level of TBARS and increase in FRAP were significantly higher in the antioxidant group compared with the placebo group (TBARS: placebo 1.2+/-2.7 vs antioxidant 3.5+/-3.4 nmol/mL; P= .001; 95% CI 0.96, 3.55; FRAP: placebo -5.6+/-154.9 vs antioxidant 97.8+/-134.9 microMFe(+2) liberated, P= .001, 95% CI 44.98, 161.7).


CONCLUSIONS
Antioxidant supplementation was effective in relieving pain and reducing levels of oxidative stress in patients with CP.
Bhardwaj
Payal
P
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Garg
Pramod Kumar
PK
Maulik
Subir Kumar
SK
Saraya
Anoop
A
Tandon
Rakesh Kumar
RK
Acharya
Subrat Kumar
SK
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D000975:Antioxidants / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers; D015220:Calcium Channels; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009419:Nerve Tissue Proteins / Q000037:antagonists & inhibitors; D018384:Oxidative Stress; D010146:Pain / Q000188:drug therapy*; D050500:Pancreatitis, Chronic / Q000503:physiopathology*; D000074025:TRPA1 Cation Channel; D050051:Transient Receptor Potential Channels / Q000037:antagonists & inhibitors
D000700:Analgesics; D000975:Antioxidants; D015415:Biomarkers; D015220:Calcium Channels; D009419:Nerve Tissue Proteins; D000074025:TRPA1 Cation Channel; C473350:TRPA1 protein, human; D050051:Transient Receptor Potential Channels